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      • Diagnosis of Suspicion: The Key to an Early Diagnosis of Fibrolamellar Hepatocellular Carcinoma

        ( Seung Woon Park ),( Soon Ho Um ),( Sun Young Yim ),( Tae Hyung Kim ),( Jemma Ahm ),( Eun Sun Kim ),( Bora Keum ),( Yeon Seok Seo ),( Yoon Tae Jeen ),( Hoon Jai Chun ),( Hong Sik Lee ),( Chang Duck K 대한내과학회 2015 대한내과학회 추계학술대회 Vol.2015 No.1

        Fibrolamellar hepatocellular carcinoma (FLHCC) is a rare form of hepatocellular carcinoma. The prevalence in Korea remains to be clarified and a few cases are reported so far. It usually occurs in young people without underlying liver disease. Although it has distinct radiologic and histologic features, liver enzymes and serum Α-fetoprotein (AFP) have no significance leading to difficult early diagnosis. Clinicians should be aware of the possibility of FLHCC in young patient and dynamic image studies should be considered. A 21 year-old Korean man was admitted to department of hepatology due to newly developed right diaphragmatic elevation in chest X-ray. He complained of abdominal pain. His laboratory tests showed mild elevation of liver enzymes. Viral markerswere negative. The positive finding in tumor marker was elevated PIVKA-II. No elevation was observed in AFP. Hepatic lesion was suspected and imaging studies were performed. Chest computed tomography shows a enhancing hepatic mass with central calcifications (Fig. A). Liver magnetic resonance imaging with primovist shows a lobulated contoured mass with low signal intensity central scar, suggestive of FLHCC (Fig.B). He underwent liver resection. Microscopically, the cords of neoplastic hepatocytes were separated by parallel arrays of collagenous stroma, stained blue in Masson’s trichrome stain (Fig. C). The tumor cells had large, vesicular nuclei with prominent nucleoli and eosinophilic cytoplasm (Fig. D). It was diagnosed as FLHCC. No recurrence was observed during follow up.

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